ABOUT US
NOTICE of PRIVACY PRACTICES
for
BISHOP WICKE HEALTH CENTER, SHARON HEALTH CARE CENTER, AND SUMMERFIELD HEALTH CARE CENTER
THIS NOTICE DESCRIBES HOW MEDICAL/HEALTH INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE
CALL:
BISHOP WICKE HEALTH CENTER: (203) 929-5321
SHARON HEALTH CARE CENTER: (860) 364-1002
SUMMERFIELD HEALTHCARE CENTER: (765) 795-4260
THE EFFECTIVE DATE OF THIS PRIVACY NOTICE IS APRIL
14, 2003.
United Methodist Homes respects the privacy and confidentiality of your
health information. This Notice of Privacy Practices (“Notice”)
describes how we may use and disclose your medical/health information
and how you can get access to this information. This Notice applies to
uses and disclosures we may make of all your health information whether
created or received by us.
I. OUR RESPONSIBILITIES TO YOU
We are required by law to:
1. Maintain the privacy of your health information and
to provide you with notice of our legal duties and privacy practices.
2. Comply with the terms of our Notice currently in
effect.
We reserve the right to change our practices and to make the new provisions
effective for all health information we maintain, including both health
information we already have and health information we create or receive
in the future. Should we make material changes, we will make the revised
Notice available to you by posting it off the main corridor outside the
recreation room.
II. HOW WE WILL USE AND DISCLOSE YOUR HEALTH INFORMATION FOR TREATMENT,
PAYMENT AND HEALTH CARE OPERATIONS
We may use and disclose your health information for purposes of treatment,
payment, and health care operations as described below.
1. For Treatment. We may use and disclose your health information
to provide you with treatment and services and to coordinate your continuing
care. Your health information may be used by doctors and nurses, as well
as by lab technicians, dieticians, physical therapists, or other personnel
involved in your care, both within our facility and with other health
care providers involved in your care. For example, a pharmacist will need
certain information to fill a prescription ordered by your doctor. We
may also disclose your health information to persons or facilities that
will be involved in your care after you leave our facility.
2. For Payment. We may use and disclose your health information
so that we can bill and receive payment for the treatment and services
you receive. For billing and payment purposes, we may disclose your health
information to an insurance or managed care company, Medicare, Medicaid,
or another third party payor. For example, we may contact Medicare or
your health plan to confirm your coverage or to request approval for a
proposed treatment or service.
3. For Health Care Operations. We may use and disclose your health
information as necessary for our internal operations, such as for general
administration activities and to monitor the quality of care you receive
with us. For example, we may use your health information to evaluate and
improve the quality of care you received, for education and training purposes,
and for planning for services. Health information may be used to evaluate
our employees and to review the qualifications and practices of doctors
and other practitioners at United Methodist Homes.
III. OTHER USES AND DISCLOSURES WE MAY MAKE WITHOUT YOUR WRITTEN
AUTHORIZATION
Under the Privacy Regulations, we may make the following uses and disclosures
without obtaining a written authorization from you:
1. As Required By Law. We may disclose your health information
when required by law to do so.
2. United Methodist Homes Directory. Unless you object, we may
use and disclose certain limited information about you in our directory
while you are a patient. This information may include your name, your
location in a facility operated by United Methodist Homes, your general
condition, and your religious affiliation. Our directory does not include
specific medical information about you. We may disclose directory information,
except for your religious affiliation, to people who ask for you by name.
We may provide the directory information, including your religious affiliation,
to a member of the clergy.
3. Persons Involved in Your Care or Payment for Your Care. Unless
you object, we may disclose health information about you to a family member,
close personal friend, or other person you identify, including clergy,
who is involved in your care. These disclosures are limited to information
relevant to the person’s involvement in your care or in arranging
payment for your care.
4. Public Health Activities. We may disclose your health information
for public health activities.
5. Reporting Victims of Abuse, Neglect or Domestic Violence. If
we believe that you have been a victim of abuse, neglect, or domestic
violence, we may use and disclose your health information to notify a
government authority, if authorized by law or if you agree to the report.
6. Health Oversight Activities. We may disclose your health information
to a health oversight agency for activities authorized by law. A health
oversight agency is a state or federal agency that oversees the health
care system. Some of the activities may include, for example, audits,
investigations, inspections, and licensure actions.
7. Judicial and Administrative Proceedings. We may disclose your
health information in response to a court or administrative order. We
also may disclose information in response to a subpoena, discovery request,
or other lawful process.
8. Law Enforcement. We may disclose your health information for
certain law enforcement purposes, including, for example, to file reports
required by law or to report emergencies or suspicious deaths; to comply
with a court order, warrant, or other legal process; to identify or locate
a suspect or missing person; or to answer certain requests for information
concerning crimes.
9. Coroners, Medical Examiners, Funeral Directors, Organ Procurement
Organizations. We may release your health information to a coroner,
medical examiner, funeral director and, if you are an organ donor, to
an organization involved in the donation of organs and tissue.
10. Research. Your health information may be used for research
purposes, but only if: (1) the privacy aspects of the research have been
reviewed and approved by a special Privacy Board or Institutional Review
Board and the Board can legally waive patient authorizations otherwise
required by the Privacy Regulations; (2) the researcher is collecting
information for a research proposal; (3) the research occurs after your
death; or (4) if you give written authorization for the use or disclosure.
11. To Avert a Serious Threat to Health or Safety. When necessary
to prevent a serious threat to your health or safety, or the health or
safety of the public or another person, we may use or disclose your health
information to someone able to help lessen or prevent the threatened harm.
12. Military and Veterans. If you are a member of the armed forces,
we may use and disclose your health information as required by military
command authorities. We may also use and disclose health information about
you if you are a member of a foreign military as required by the appropriate
foreign military authority.
11. National Security and Intelligence Activities; Protective Services
for the Patient and Others. We may disclose health information to
authorized federal officials conducting national security and intelligence
activities or as needed to provide protection to the Patient of the United
States, certain other persons, or foreign heads of states or to conduct
certain special investigations.
12. Inmates/Law Enforcement Custody. If you are an inmate of a
correctional institution or under the custody of a law enforcement official,
we may disclose your health information to the institution or official
for certain purposes including your own health and safety as well as that
of others.
13. Workers’ Compensation. We may use or disclose your health
information to comply with laws relating to workers' compensation or similar
programs.
14. Disaster Relief. We may disclose health information about
you to an organization assisting in a disaster relief effort.
15. Fundraising Activities. We may use limited health information
such as your name, address and phone number, and the dates you received
treatment or services, to contact you in an effort to raise money for
United Methodist Homes. We may also disclose contact information for fundraising
purposes to a foundation related to United Methodist Homes.
16. Appointment Reminders. We may use or disclose health information
to remind you about appointments.
17. Treatment Alternatives and Health-Related Benefits and Services.
We may use or disclose your health information to inform you about treatment
alternatives and health-related benefits and services that may be of interest
to you.
18. Business Associates. We may disclose your health information
to our business associates under a Business Associate Agreement.
IV. YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR ALL OTHER USES OR
DISCLOSURES OF YOUR HEALTH INFORMATION
1. We will obtain your written authorization (an “Authorization”)
prior to making any use or disclosure other than those described above.
2. A written Authorization is designed to inform you
of a specific use or disclosure, other than those set forth above, that
we plan to make of your health information. The Authorization describes
the particular health information to be used or disclosed and the purpose
of the use or disclosure. Where applicable, the written Authorization
will also specify the name of the person to whom we are disclosing the
health information. The Authorization will also contain an expiration
date or event.
3. You may revoke a written Authorization previously
given by you at any time but you must do so in writing. If you revoke
your Authorization, we will no longer use or disclose your health information
for the purposes specified in that Authorization except where we have
already taken actions in reliance on your Authorization.
V. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding your health information:
1. Right to Request Restrictions. You have the right to request
that we restrict the way we use or disclose your health information for
treatment, payment, or health care operations. However, we are not required
to agree to the restriction. If we do agree to a restriction, we will
honor that restriction except in the event of an emergency and will only
disclose the restricted information to the extent necessary for your treatment.
2. Right to Request Confidential Communications. You have the
right to request that we communicate with you concerning your health matters
in a certain manner or at a certain location. For example, you can request
that we contact you only at a certain phone number. We will accommodate
your reasonable requests.
3. Right of Access to Personal Health Information. You have the
right to inspect and, upon written request, obtain a copy of your health
information except under certain limited circumstances. Under Connecticut
law, if the United Methodist Homes makes a copy of your medical record,
we will not charge more than $0.65 per page, plus postage, plus a reasonable
fee if you want x-ray films or tissue samples.
We may deny your request to inspect or receive copies in certain limited
circumstances. If you are denied access to health information, in some
cases you will have a right to request review of the denial. This review
would be performed by a licensed health care professional designated by
a facility operated by United Methodist Homes who did not participate
in the decision to deny access.
4. Right to Request Amendment. You have the right to request that
we amend your health information. Your request must be made in writing
and must state the reason for the requested amendment. We may deny your
request for amendment if the information: (a) was not created by us, unless
you provide reasonable information that the originator of the information
is no longer available to act on your request; (b) is not part of the
health information maintained by us; (c) is information to which you do
not have a right of access; or (d) is already accurate and complete, as
determined by us.
If we deny your request for amendment, we will give you a written denial
notice, including the reasons for the denial. In that event, you have
the right to submit a written statement disagreeing with the denial. Your
letter of disagreement will be attached to your medical record.
5. Right to an Accounting of Disclosures. You have the right to
request an “accounting” of certain disclosures of your health
information. This is a listing of disclosures made by us or by others
on our behalf, but does not include disclosures for treatment, payment
and health care operations or certain other exceptions.
You must submit your request in writing and you must state the time period
for which you would like the accounting. The accounting will include the
disclosure date; the name of the person or entity that received the information
and address, if known; a brief description of the information disclosed;
and a brief statement of the purpose of the disclosure. The first accounting
provided within a 12-month period will be free; for further requests,
we may charge you our costs for completing the accounting.
6. Right to a Paper Copy of This Notice. You have the right to
obtain a paper copy of this Notice, even if you have agreed to receive
this Notice electronically. You may request a copy of this Notice at any
time. In addition, you may obtain a copy of this Notice at our website,
www.umh.org.
VI. SPECIAL REGULATIONS REGARDING DISCLOSURE OF PSYCHIATRIC, SUBSTANCE
ABUSE, AND HIV-RELATED INFORMATION
For disclosures concerning health information relating to care for psychiatric
conditions, substance abuse, or HIV-related information, special restrictions
may apply. For example, we generally may not disclose this specially protected
information in response to a subpoena, warrant, or other legal process
unless you sign a special Authorization or a court orders the disclosure.
A general release of your health information will not be sufficient for
purposes of disclosing psychiatric, substance abuse, or HIV-related information.
1. Psychiatric information. We will not disclose records relating
to a diagnosis or treatment of your mental condition between the patient
and psychiatrist, or which are prepared at a mental health facility, without
specific written Authorization or as required or permitted by law.
2. HIV-related information. HIV-related information will not be
disclosed, except under limited circumstances set forth under state or
federal law, without your specific written Authorization. A general Authorization
for release of medical or other information will not be sufficient for
purposes of releasing HIV-related information. As required by Connecticut
law, if we make a lawful disclosure of HIV-related information, we will
enclose a statement that notifies the recipient of the information that
they are prohibited from further disclosing the information.
3. Substance abuse treatment. If you are treated in a specialized
substance abuse program, information which could identify you as an alcohol
or drug-dependant patient will not be disclosed without your specific
Authorization, except where specifically required or allowed under state
or federal law.
VII. COMPLAINTS
1. If you believe that your privacy rights have been
violated, you may file a complaint in writing with us or with the Office
of Civil Rights in the U.S. Department of Health and Human Services at
200 Independence Avenue, S.W., Room 509 F, HHH Building, Washington D.C.
20201.
2. To file a complaint with us, you should contact:
Denise Boudreau-Scott, Administrator, Bishop Wicke Health Center
584 Long Hill Avenue
Shelton, CT 06484
Peter Belval, Administrator, Sharon Health Care Center
27 Hospital Hill Avenue, PO Box 1268
Sharon, CT 06069
Chris Peter, Administrator, Summerfield Health Care Center
34 South Main
Street
Cloverdale, IN 46120
3. We will not retaliate against you in any way for
filing a complaint against any facility operated by United Methodist Homes. |
